Provider Demographics
NPI:1982159240
Name:SUTTON, MEGHAN JULIA (NP)
Entity Type:Individual
Prefix:MRS
First Name:MEGHAN
Middle Name:JULIA
Last Name:SUTTON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3047 GARDNER AVE
Mailing Address - Street 2:
Mailing Address - City:BERKLEY
Mailing Address - State:MI
Mailing Address - Zip Code:48072-1375
Mailing Address - Country:US
Mailing Address - Phone:313-580-8593
Mailing Address - Fax:
Practice Address - Street 1:4201 SAINT ANTOINE ST STE 6B
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2153
Practice Address - Country:US
Practice Address - Phone:313-745-3765
Practice Address - Fax:313-745-3214
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-16
Last Update Date:2017-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704273885363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily